N26: IVPB Spring 2012 Terminology Piggyback: general term meaning ‘attach 1 tubing to another’ Continuous vs Intermittent Secondary Tubing Y-site Volume Controlled set Cabrillo College ADN/C. Madsen RN, MSN

Advantages IV route Direct (and instant) access to circulatory system N26: IVPB Spring 2012 Advantages IV route Direct (and instant) access to circulatory system Able to give drugs too irritating for gastric mucosa – or for delivering high concentrations Since IVPB (“intermittent”) usually over 30 – 60 min, can instantly d/c if reaction occurs Able to give meds when GI tract not available Cabrillo College ADN/C. Madsen RN, MSN

Disadvantages of IV route N26: IVPB Spring 2012 Disadvantages of IV route Drug interactions because of incompatibilities Sometimes drug absorbed by plastic container – full dose not delivered Speed shock Tissue injury – chemical phlebitis or when certain drugs infiltrate Cabrillo College ADN/C. Madsen RN, MSN

Before hanging med: Check expiration date on secondary tubing. N26: IVPB Spring 2012 Before hanging med: Check expiration date on secondary tubing. Does tubing have sterile cap? 5 rights, plus rate of administration compatibility of IV solution clean access (Y-site) ports with alcohol prior to each access. Cabrillo College ADN/C. Madsen RN, MSN

Compatibility & Rate of Administration N26: IVPB Spring 2012 Compatibility & Rate of Administration Drug books Davis’s Drug Guide: each drug divided into sections; find “IV Administration” section “intermittent administration” & compatibility Gahart: information under Dilution, Rate of Administration, Compatibility Intermittent IV (vs IV injection or infusion) Pharmacy Cabrillo College ADN/C. Madsen RN, MSN

Ondansetron HCL (Zofran) (Gahart & Nazareno, Intravenous Medications) N26: IVPB Spring 2012 Ondansetron HCL (Zofran) (Gahart & Nazareno, Intravenous Medications) Dilution IV injection:… Intermittent infusion: single dose should be diluted in 50 mL of NS or D5W. Also available… Compatibility Additive Y-site Rate of Administration IV injection… Intermittent infusion: single dose over 15 min. Cabrillo College ADN/C. Madsen RN, MSN

Primary IV on Infuser pump N26: IVPB Spring 2012 Primary IV on Infuser pump Y-site above the pump (‘rate controller’) Backprime “piggyback” or “secondary” function key Rate VTBI Cabrillo College ADN/C. Madsen RN, MSN

N26: IVPB Spring 2012 Primary IV to gravity Dial-a-flow or stat-master = the ‘rate controller’ Y-site above rate controller Set at desired ml/hr AND check gtts/min to verify accuracy. Maintenance solution stops while infusing an intermittent med attached above the pump or dial-a flow Cabrillo College ADN/C. Madsen RN, MSN

After hanging med Make sure it is infusing Check on pt after 5-10 min N26: IVPB Spring 2012 After hanging med Make sure it is infusing Have you opened the clamp? Check on pt after 5-10 min 6th right: document Cabrillo College ADN/C. Madsen RN, MSN

Syringe Pump “spaghetti” tubing Note where flange of syringe goes N26: IVPB Spring 2012 Syringe Pump “spaghetti” tubing Note where flange of syringe goes Attach closest to IV insertion site (below the ‘rate controller’) Maintenance solution does not stop May also connect to SL; then use SAS Cabrillo College ADN/C. Madsen RN, MSN

Saline Lock Saline Administer med N26: IVPB Spring 2012 Saline Lock Saline Administer med Used with Syringe pump, gravity tubing, or EID May or may not use “backup” solution (usually NS) Tubing may be on pump, and needs to be connected; may connect regular gravity tubing directly to Saline Lok. Cabrillo College ADN/C. Madsen RN, MSN

What if solution is incompatible? N26: IVPB Spring 2012 What if solution is incompatible? Use Primary tubing and connect to lower Y-site Turn off primary IV Flush with saline before and after or Disconnect primary IV, hang NS and use secondary tubing. Cabrillo College ADN/C. Madsen RN, MSN